Healthcare Provider Details

I. General information

NPI: 1386577849
Provider Name (Legal Business Name): LILLY LINAKSITA TJITRO RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50100 GOLSH RD
VALLEY CENTER CA
92082-5338
US

IV. Provider business mailing address

PO BOX 406
PAUMA VALLEY CA
92061-0406
US

V. Phone/Fax

Practice location:
  • Phone: 760-749-1410
  • Fax: 760-233-5597
Mailing address:
  • Phone: 760-749-1410
  • Fax: 760-233-5597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH47833
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: